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Background and aims: Trends in patient selection and use of pharmacotherapy prior to catheter ablation (CA) for supraventricular tachycardia (SVT) are not well described. This study examined temporal trends in patients undergoing first-time CA for regular SVT, including atrioventricular nodal re-entry tachycardia (AVNRT), accessory pathways (APs), and ectopic atrial tachycardia (EAT) on a nationwide scale in Denmark in the period 2001–2018. Methods and results: Using Danish Nationwide registers, 9959 patients treated with first-time CA for SVT between 2001 and 2018 were identified, of which 6023 (61%) received CA for AVNRT, 2829 (28%) for AP, and 1107 (11%) for EAT. Median age was 55, 42, and 55 in the AVNRT, APs, and EAT group, respectively. The number of patients receiving CA increased from 1195 between 2001 and 2003 to 1914 between 2016 and 2018. The percentage of patients with a CHA2DS2-VASc score ≥ 2 increased in all patient groups. The number of patients who underwent CA with no prior use of antiarrhythmic- or rate limiting medicine increased significantly, though prior use of beta-blockers increased for AVNRT patients. Use of verapamil decreased in all three SVT groups (P < 0.05). Use of amiodarone and class 1C antiarrhythmics remained low, with the highest usage among EAT patients. Conclusion: Between 2001 and 2018, CA was increasingly performed in patients with SVT, primarily AVNRT- and EAT patients. The burden of comorbidities increased. Patients undergoing CA without prior antiarrhythmic- or rate-limiting drug therapy increased significantly. Use of beta-blockers increased and remained the most widely used drug. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common heart rhythm disorder. According to current recommendations, the treatment of AF includes 3 main directions: "A" – the appointment of anticoagulant therapy with an increased risk of thromboembolic complications, "B" – control of arrhythmia symptoms, choice of a strategy for rhythm control or control of ventricular contractions, "C" – treatment of concomitant diseases and correction of risk factors. The rhythm control strategy includes performing cardioversion, prescribing long-term antiarrhythmic therapy, or performing radiofrequency catheter ablation. According to the latest recommendations of 2020, antiarrhythmic drugs of IC and III classes are currently used for pharmacological cardioversion of AF and long-term retention of sinus rhythm. The choice of a specific antiarrhythmic drug is based on its safety and effectiveness. â-Blockers, non-dihydropyridine calcium channel blockers and digoxin are used to control CHS. The results of modern research have significantly expanded our understanding of the molecular mechanisms underlying various forms of AF. Currently, the search for new drugs is actively underway that will allow preventing the development of AF and its progression at the molecular level.

The article discusses the safety of antiarrhythmic therapy for atrial fibrillation in the light of the development of cardiac and non-cardiac side effects, the presence of drug-drug interactions of antiarrhythmic drugs in the near (with anticoagulants) and far circle. The features of the choice of antiarrhythmic therapy for the prevention of relapses of atrial fibrillation, restoration of sinus rhythm, as well as heart rate control are presented, and aspects of the tactics of managing these patients are highlighted.

An electrical storm (ES) is defined as the presence of at least three episodes of sustained ventricular tachycardia or ventricular fibrillation within 24 h. This patient had a previously known arterial hypertension, type II diabetes mellitus, and chronic kidney disease and has presented to the Emergency Department (ED) with symptoms of retrosternal chest pain lasting for several hours prior. The initial 12-lead electrocardiogram revealed ST segment elevation in the anterior leads (V1–V6). Emergent coronary angiography revealed an acute occlusion of the proximal left anterior descending artery (pLAD) and percutaneous coronary intervention was performed with successful implantation of one drug-eluting stent in the pLAD. On day 8 of hospitalization, the patient developed a refractory ES for which he received 50 DC shocks and did not respond to multiple lines of antiarrhythmic medications. Due to a failure of medical therapy, we decided to implant a temporary pacemaker and initiate ventricular overdrive pacing (VOP) that was successful in terminating ES. Following electrical stabilization, the patient underwent a successful ICD implantation. This case demonstrates that VOP can contribute to hemodynamic and electrical stabilization of a patient that suffers from refractory ES and this treatment modality might serve as a temporary bridge to ICD implantation.

An electrical storm (ES) is defined as the presence of at least three episodes of sustained ventricular tachycardia or ventricular fibrillation within 24 h. This patient had a previously known arterial hypertension, type II diabetes mellitus, and chronic kidney disease and has presented to the Emergency Department (ED) with symptoms of retrosternal chest pain lasting for several hours prior. The initial 12-lead electrocardiogram revealed ST segment elevation in the anterior leads (V1–V6). Emergent coronary angiography revealed an acute occlusion of the proximal left anterior descending artery (pLAD) and percutaneous coronary intervention was performed with successful implantation of one drug-eluting stent in the pLAD. On day 8 of hospitalization, the patient developed a refractory ES for which he received 50 DC shocks and did not respond to multiple lines of antiarrhythmic medications. Due to a failure of medical therapy, we decided to implant a temporary pacemaker and initiate ventricular overdrive pacing (VOP) that was successful in terminating ES. Following electrical stabilization, the patient underwent a successful ICD implantation. This case demonstrates that VOP can contribute to hemodynamic and electrical stabilization of a patient that suffers from refractory ES and this treatment modality might serve as a temporary bridge to ICD implantation. [ABSTRACT FROM AUTHOR]

Abstract. Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias. The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus. Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol. Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p

The widespread introduction of catheter-based treatment for atrial fibrillation has led to a significant increase in the number of patients undergoing this procedure. Understanding the disease characteristics in the early period following catheter-based treatment is an important component of the systemic treatment of such patients, which improves both immediate and long-term outcomes. This time interval is referred to as the blanking period, it lasts for 3 months and may usually be accompanied by recurrent or even more frequent arrhythmia episodes. This publication discusses modern approaches and methods for managing and treating patients with atrial fibrillation specifically during the blanking period.

The article analyzes the case of the development of ventricular tachycardia and type 2 myocardial infarction (MI) in an 80-year-old patient with a history of coronary artery disease, MI and chronic heart failure. In 2020, the patient was diagnosed with ventricular extrasystole and started antiarrhythmic therapy with diethylamino propionylethoxycarbonylaminophenothiazine 150 mg per day and sotalol 160 mg per day. In 2022, the patient had an episode of clinical death due to ventricular tachycardia with successful resuscitation. A diagnosis of non-ST-elevation acute coronary syndrome was made, coronary angiography was performed, which did not reveal significant coronary stenosis. Upon further examination, the dynamics of biomarkers of myocardial necrosis confirmed the diagnosis of acute MI. In the analyzed case, the development of ventricular tachycardia and MI is most likely associated with the intake of diethylaminopropionylethoxycarbonylaminophenothiazine in combination with sotalol, prescribed in the presence of contraindications to their use.

Atrioventricular reentrant tachycardia (AVRT) is the most common form of supraventricular tachycardia in newborns. AVRT is sometimes refractory to conventional antiarrhythmic therapy. We describe our experience about the use of the triple combination of flecainide + propranolol + amiodarone as third-line regimen for refractory and recurrent AVRT in newborns. We considered a series of 14 patients who had failed both first-line and second-line therapy and were treated using the combination of flecainide + propranolol + amiodarone. Transoesophageal electrophysiologic study (TES) was performed to test the effectiveness of medical therapy during hospitalization and to try to reduce the amount of therapy, after amiodarone wash-out, before 1 year of age. TES was repeated at 1 year of age to test the spontaneous resolution of the arrhythmia after treatment discontinuation. Rhythm control was achieved in all 14 patients. At a mean age of 9.3 ± 2 months, AVRT was not inducible by TES in 11/12 amiodarone-free patients. At a mean age of 14.1 ± 3 months, AVRT was still inducible in 7/12 patients after interrupting the entire antiarrhythmic therapy (58.3%). Triple combination was effective as third-line option to suppress AVRT refractory to single and double antiarrhythmic therapy, with no significant adverse events. Our experience suggests that triple therapy could be maintained for a short-term treatment, discontinuing amiodarone before 1 year of age to avoid long-term side effects. Newborns who needed triple therapy appear to have a lower chance of accessory pathway disappearance at 1 year of age. TES could be useful for risk stratification of recurrences at the time of drug discontinuation in infants considered to be at higher risk of recurrent AVRT. [ABSTRACT FROM AUTHOR]

Aims Prevalent atrial fibrillation (AF) is associated with excess cardiovascular (CV) death (D) and hospitalizations (H) in heart failure (HF) with preserved ejection fraction (pEF). We evaluated if it had an independent role in excess CVD in HFpEF and studied its impact on cause-specific mortality and HF morbidity. Methods and results We used propensity score–matched (PSM) cohorts from the TOPCAT Americas trial to account for confounding by other co-morbidities. Two prevalent AF presentations at study entry were compared: (i) subjects with Any AF event by history or on electrocardiogram (ECG) with PSM subjects without an AF event and (ii) subjects in AF on ECG with PSM subjects in sinus rhythm. We analyzed cause-specific modes of death and HF morbidity during a mean follow-up period of 2.9 years. A total of 584 subjects with Any AF event and 418 subjects in AF on ECG were matched. Any AF was associated with increased CVH [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.11–1.61, P = 0.003], HFH (HR 1.44, 95% CI 1.12–1.86, P = 0.004), pump failure death (PFD) (HR 1.95, 95% CI 1.05–3.62, P = 0.035), and HF progression from New York Heart Association (NYHA) classes I/II to III/IV (HR 1.30, 95% CI 1.04–1.62, P = 0.02). Atrial fibrillation on ECG was associated with increased risk of CVD (HR 1.46, 95% CI 1.02–2.09, P = 0.039), PFD (HR 2.21, 95% CI 1.11–4.40, P = 0.024), and CVH and HFH (HR 1.37, 95% CI 1.09–1.72, P = 0.006 and HR 1.65, 95% CI 1.22–2.23, P = 0.001, respectively). Atrial fibrillation was not associated with risk of sudden death. Both Any AF and AF on ECG cohorts were associated with PFD in NYHA class III/IV HF. Conclusion Prevalent AF can be an independent risk factor for adverse CV outcomes by its selective association with worsening HF, HFH, and PFD in HFpEF. Prevalent AF was not associated with excess sudden death risk in HFpEF. Atrial fibrillation was also associated with HF progression in early symptomatic HFpEF and PFD in advanced HFpEF. Trial registration TOPCAT trial is registered at www.clinicaltrials.gov :identifier NCT00094302. [ABSTRACT FROM AUTHOR]

The article presents data on the most commonly used antiarrhythmic drugs of subclass IC: propafenone, flecainide, and a drug manufactured in Latvia — ethacizine. The features and priority areas of each drug use were identified. The author conducted a critical analysis of the results of Cardiac Arrhythmia Suppression Trials (CAST)-I and CAST-II and suggested ways to further study of subclass IC antiarrhythmic drugs in the context of current treatment strategies. The results of CAST-I and CAST-II should be interpreted in view of the heterogeneity of the subclass IC antiarrhythmic drugs and the fact that among the drugs of this subclass that are currently registered and approved for use in Ukraine, only flecainide was studied in CAST-I, and none of these drugs — in CAST-II. Ethacizine has a special position as a promising drug, especially effective in the treatment of vagus-induced heart rhythm disorders, with a small number of contraindications and drug interactions compared with propafenone and flecainide. Despite many years of use in several countries, this drug remains "invisible" to researchers around the world due to a limited number of international studies. The author draws attention to the need to re-evaluate antiarrhythmic drugs with an outdated evidence, in some cases quite limited, and to plan new experimental studies to clarify the possibility of subclass IC drugs to influence new pharmacological targets in arrhythmology, as well as large-scale well-planned studies of the safety and efficacy of subclass IC antiarrhythmic drugs in real present-day clinical practice. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most frequent chronic arrhythmia worldwide, and it is associated with significant morbidity and mortality, making it a considerable burden both to patients and the healthcare system. Nowadays, an early attempt to restore sinus rhythm in acute symptomatic AF through electrical or pharmacological cardioversion is the most common approach in the Emergency Department (ED). However, considering the high percentage of spontaneous cardioversion of paroxysmal AF reported by many studies, this approach may not be the ideal choice for all patients. In this manuscript we performed a review of the most relevant studies found in literature with the aim of identifying the main determinants of spontaneous cardioversion, focusing on those easy to detect in the ED. We have found that the most relevant predictors of spontaneous cardioversion are the absence of Heart Failure (HF), a small atrial size, recent-onset AF, rapid Atrial Fibrillatory Rate and the relationship between a previous AF episode and Heart Rate/Blood Pressure. A number of those are utilized, along with other easily determined parameters, in the recently developed "ReSinus" score which predicts the likelihood of AF spontaneous cardioversion. Such identification may help the physician decide whether immediate cardioversion is necessary, or whether to adopt a "watch-and-wait" strategy in the presence of spontaneous cardioversion determinants. [ABSTRACT FROM AUTHOR]

Background: Antiarrhythmic treatment of fetal supraventricular tachycardia (SVT) is used to prevent morbidity and mortality. The postnatal management of survivors is often arbitrary and varied.Objective: The purpose of this study was to examine the utility of a risk-based postnatal management strategy.Methods: Sixty-six prenatally treated newborns with fetal long or short ventriculoatrial tachycardia were reviewed. Postnatal diagnoses included atrioventricular reentrant tachycardia, atrial ectopic tachycardia, and permanent junctional reciprocating tachycardia. Unless SVT persisted to birth, early neonatal observation without treatment was recommended. For newborns without spontaneous arrhythmia after ≥2 days of observation, inducibility was tested by transesophageal pacing study (TEPS). Postnatal therapy was advised for spontaneous or inducible SVT. Characteristics associated with these outcomes were analyzed.Results: Twenty-eight patients (42%) experienced SVT at or early after birth, which was associated with fetal long ventriculoatrial tachycardia (odds ratio [OR] 6.8; 95% confidence interval [CI] 1.88-24.57; P = .0029); delayed in utero cardioversion with treatment (median 11 days vs 5.5 days; P < .0001); prenatal treatment with multiple antiarrhythmics (OR 4.42; 95% CI 1.56-12.55; P = .0059); and postnatal atrial ectopic tachycardia/permanent junctional reciprocating (OR 18.0; 95% CI 2.11-153.9; P = .0013). Of the 38 neonates undergoing TEPS, 19 (50%) had inducible tachyarrhythmias. Recurrence of SVT during infancy or childhood was documented in 4 of 6 patients with SVT at birth (66%), 8 of 22 patients with early neonatal SVT (36%), 4 of 19 patients with inducible SVT (21%), and 0 of 19 untreated patients without inducible SVT (0%) (P = .0032).Conclusion: The postnatal risk of SVT is related to the arrhythmia mechanism and prenatal treatment response. In newborns without spontaneous SVT, TEPS may be useful to guide the need for postnatal treatment on the basis of SVT inducibility. [ABSTRACT FROM AUTHOR]

Aims: Catheter ablation is superior to escalated antiarrhythmic drugs among patients with ventricular tachycardia (VT) and prior myocardial infarction (MI). However, it is uncertain whether clinical VT characteristics, should influence choice of therapy. The purpose of this study was to evaluate whether presentation with electrical storm and the clinical VT cycle length predicted response to ablation vs. escalated antiarrhythmic therapy.Methods and Results: All patients enrolled in the Ventricular Tachycardia Ablation vs. Escalated Antiarrhythmic Drug Therapy in Ischaemic Heart Disease (VANISH) trial were included. The association between VT cycle length and presentation with electrical storm and the primary outcome of death, subsequent VT storm or appropriate ICD shock was evaluated. Among the study population of 259 patients, escalated antiarrhythmic drug therapy had worse outcomes for those presenting with a VT cycle length >400 ms [<150 b.p.m., 89/259, hazard ratio (HR) 1.7 (1.02-3.13)]. This effect was more pronounced among those taking amiodarone at baseline [HR of 2.22 (1.19-4.16)]. Presentation with VT storm (32/259) did not affect the primary outcome between groups. However, those presenting with VT storm on amiodarone had a trend towards worse outcomes with escalated antiarrhythmic therapy [HR 4.31 (0.55-33.93)].Conclusion: The VT cycle length can influence response to either ablation or escalated drug therapy in patients with VT and prior MI. Those with slow VT had improved outcomes with ablation. Patients presenting with electrical storm demonstrated similar outcomes to the overall trial population, with a trend to benefit of catheter ablation, particularly in those on amiodarone. [ABSTRACT FROM AUTHOR]

Supraventricular tachyarrhythmias pose a significant challenge in neonates and infants, particularly within the first year of life, where prompt and effective management is crucial. By synthesizing available evidence and clinical experience, this review aims to provide a comprehensive overview of antiarrhythmic therapy in this vulnerable population, with a focus on narrow QRS supraventricular tachyarrhythmias. This review examines the current understanding of supraventricular tachyarrhythmia management and discusses the challenges associated with antiarrhythmic therapy in newborns and infants during the critical first year of life, evaluating the efficacy and safety of various antiarrhythmic agents commonly utilized in this population, including dosing considerations, adverse effects, and strategies for acute management and prophylactic long-term antiarrhythmic treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Indian Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.)

Aim. To evaluate the effectiveness of beta-blockers (BB) in the treatment of idiopathic premature ventricular contractions (PVCs) in children.Material and methods. BBs were prescribed to 27 children with idiopathic PVCs. In 3 (11,1%) patients, side effects (hypotension, bronchial obstruction) was revealed at the beginning of therapy. A total of 24 children were included in the further study (15 boys (62,5%), 9 girls (37,5%). The mean age was 8,3±5,4 years. Data from anamnesis, electrocardiography (ECG), 24-hour ECG monitoring, and echocardiography were analyzed.Results. The 24-hour PVC rate was 33,2±17,7 thousand/day or 26,6±13,2%. In 14 (58,3%) children, we recorded paired PVCs, in 3 (12,5%) — multiform, in 10 (41,7%) — runs of non-sustained VT. There were complaints in 7 (29,2%) children. The follow-up period lasted 369,8±119,1 days. Propranolol was received by 17 (70,8%) patients, metoprolol — by 7 (29,2%). The therapy was effective in 11 (45,8%) patients, while ineffective in 13 (54,2%), among which 5 (20,8%) had an increase in the number of PVCs. The effectiveness of BBs was higher in children under the age of 1 year (p=0,043). Propranolol showed greater efficacy than metoprolol (p=0,047). Less efficiency was observed in female patients and those with pathological heart rate turbulence parameters (p=0,04).Conclusion. The effectiveness of BBs in children with idiopathic PVCs is 45,8%, higher in children aged

Background: Amiodarone has a profound adverse toxicity profile. Large population-based analyses quantifying the risk of thyroid dysfunction (TD) in adults with and without congenital heart disease (ACHD) are lacking. Methods: All adults registered with a major German health insurer (≈9.2 million members) with amiodarone prescriptions were analyzed. Occurrence of amiodarone-associated TD was assessed. Results: Overall, 48,891 non-ACHD (37% female; median 73 years) and 886 ACHD (34% female; median 66 years) received amiodarone. Over 184,787 patient-years, 10,875 cases of TD occurred. The 10-year risk for TD was 38% in non-ACHD (35% ACHD). Within ACHD, compared to amiodarone-naïve patients, the hazard ratio (HR) for TD was 3.9 at 4 years after any amiodarone exposure. TD was associated with female gender (HR 1.42, p < 0.001) and younger age (HR 0.97 per 10 years, p = 0.009). Patients with congenital heart disease were not at increased risk (HR 0.98, p = 0.80). Diagnosis of complex congenital heart disease, however, was a predictor for TD (HR 1.56, p = 0.02). Amiodarone was continued in 47% of non-ACHD (38% ACHD), and 2.3% of non-ACHD (3.5% ACHD) underwent thyroid surgery/radiotherapy. Conclusions: Amiodarone-associated TD is common and comparable in non-ACHD and ACHD. While female gender and younger age are predictors for TD, congenital heart disease is not necessarily associated with an elevated risk. [ABSTRACT FROM AUTHOR]

Backround. The study of the atrial fibrillation (AF) dependence on the activity of the hypothalamic-pituitary-reproductive system in women has important theoretical and practical significance. Recent studies have reflected data on the close relationship of AF with age-related aging. Most authors consider it necessary to study noninvasive methods to assess the conductive structures of the heart and to select rational schemes of recurrent therapy in this category of patients. The task of present work is to develop adequate methods for assessment of the cardiac conduction system and rational pharmacotherapy schemes for treatment of atrial fibrillation at the stages of reproductive aging of women using noninvasive methods of heart research. Material and methods. 184 women with paroxysms of AF (PAF) were examined, and divided into 3 groups. The 1st group includes 128 patients when PAF occurred at the postmenopausal period. The 2nd group includes 34 women who have PAF at the stage of transition to menopause. The 3rd group includes 22 women who have PAF in the reproductive period. Clinical and instrumental research methods include transesophageal electrocardiostimulation (TECS), Holters' monitoring of an electrocardiogram (ECG) and echocardiography (EchoCG). Results. It has found that in women, sensitivity of transesophageal stimulation of the heart in inducing PAF in the 1st group is 89.1%, in the 2nd - 73.5% and in the 3rd – 18.2%; the predictive value of a positive result are 98.3, 92.6 and 66.7%, and a negative result are 27.7, 49.1 and 51.9%, respectively; the specificity of the method is 93.3%. It has been shown that the first-line drugs for the prevention of PAF in women are cordarone and propanorm. It was revealed that in the combined therapy of PAF in women, the first stage is a combination of class I antiarrhythmic drugs with sotalol, the second stage is with cordarone. Conclusions. The data shows high informative of electrophysiological studies in the diagnosis and selection of therapy for atrial fibrillation in women.

Atrial fibrillation (AF) is the most common heart rhythm disorder requiring treatment and is associated with an increased rate of hospitalization and death. When choosing the tactics of restoring and maintaining sinus rhythm in most patients with AF paroxysm without pronounced organic heart damage, the drug of choice is propafenone, which has a high level of safety and efficacy. The use of the drug within the framework of a «pill in a pocket» by the patient himself, intravenously in a day hospital of an outpatient medical institution or by an ambulance team allows stopping AF paroxysm in most patients at the prehospital stage. Propafenone is also the drug of choice for inpatient sinus rhythm restoration and for long-term antiarrhythmic therapy in a wide range of patients with AF.

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Atrial fibrillation (AF) is a worldwide epidemic that has hit about 33 million people. In clinical studies, the efficacy of antiarrhythmic therapy and catheter ablation in the treatment of AF was compared, and controversial results were obtained. Objective. To analyze three advanced publications in recent years, which, according to the authors, are of fundamental importance for the choice of radiofrequency catheter ablation as a treatment option for AF. Results and discussion. In the CABANA study catheter ablation was compared with antiarrhythmic therapy and showed significant improvement in the quality of life. Within 3 years, AF recurrence rate was 69% in the group of antiarrhythmic treatment and 50% in the catheter ablation group. The proportion of patients with non-paroxysmal AF decreased from 57% to 26% with antiarrhythmic treatment and up to 16% with catheter ablation. Among the serious complications in the catheter ablation group were tamponades (0.8%), minor hematomas (2.3%) and pseudoaneurysms (1.1%). Thyroid dysfunction (1.6%) and proarrhythmogenic effect (0.8%) were observed in the group of antiarrhythmic therapy. In the CASTLE-AF (HF) study, 179 patients were randomly selected for catheter ablation, and 184 for antiarrhythmic therapy. All of them were in NYHA class II, III or IV, had left ventricular ejection fraction 35% or less, and used implantable defibrillator. In the mean follow-up of 37.8 months, significantly less patients died after catheter ablation (24 [13.4%] versus 46 [25.0%]), and less were hospitalized due to worsening heart failure (37 [20.7%] versus 66 [35.9%]). ATTEST is the first randomized controlled trial that has demonstrated slowing down of the progression of AF after catheter ablation. Radiofrequency ablation was performed in 128 patients, antiarrhythmic therapy was applied in 127 patients. Within 3 years, the incidence of persistent AF or atrial tachycardia was lower in patients treated with ablation compared with patients on antiarrhythmic therapy (2.4% vs. 17.5%; P = 0.0009). Conclusions. The expected benefit of catheter ablation of AF in comparison with drug therapy is as follows: increase in the probability of maintaining sinus rhythm, improvement of the quality of life, decrease in the number of hospitalizations and all-cause mortality in patients with heart failure, decrease in fatigue.

Atrial fibrillation (AF) is the most frequent chronic arrhythmia worldwide, and it is associated with significant morbidity and mortality, making it a considerable burden both to patients and the healthcare system. Nowadays, an early attempt to restore sinus rhythm in acute symptomatic AF through electrical or pharmacological cardioversion is the most common approach in the Emergency Department (ED). However, considering the high percentage of spontaneous cardioversion of paroxysmal AF reported by many studies, this approach may not be the ideal choice for all patients. In this manuscript we performed a review of the most relevant studies found in literature with the aim of identifying the main determinants of spontaneous cardioversion, focusing on those easy to detect in the ED. We have found that the most relevant predictors of spontaneous cardioversion are the absence of Heart Failure (HF), a small atrial size, recent-onset AF, rapid Atrial Fibrillatory Rate and the relationship between a previous AF episode and Heart Rate/Blood Pressure. A number of those are utilized, along with other easily determined parameters, in the recently developed “ReSinus” score which predicts the likelihood of AF spontaneous cardioversion. Such identification may help the physician decide whether immediate cardioversion is necessary, or whether to adopt a “watch-and-wait” strategy in the presence of spontaneous cardioversion determinants.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

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Due to the spectacular progress made in human genomic studies, molecular biology and genetics have become an essential part of modern medicine making it possible to early detect the risk factors and select the personalized treatment. The genetic studies have been widely used in the diagnosis and treatment of arrhythmias. Significant advances in the study of electrophysiological and genetic mechanisms of life-threatening arrhythmias have been achieved through studies of familial conditions with high risk of sudden cardiac death. However, the area of special interest for a practitioner is the identification of mutations associated with atrial fibrillation (AF). The novel methods enable us to study histological, structural, cellular and molecular causes of this arrhythmia. The two main directions of molecular genetic studies of AF are the identification of genetic mutations causing familial atrial fibrillation and the study of different genes polymorphism predisposing to arrhythmia in general population. Gene polymorphism screening helps both identify AF risk factors and predict its evolution from paroxysmal to chronic type. Emerging genetic studies provided explanation for the variable efficacy of antiarrhythmic drugs. It can be assumed that the clinical use of genetic methods will allow accurate and personalized selection of antiarrhythmics. Currently, therapeutic drug monitoring is widely recommended for a number of medications including cytostatics, aminoglycosides, anticonvulsants, and, by some researchers, antiarrhythmic and anticoagulant drugs. Medicine from the very beginning was intended to be personalized, but until recently it was a little more than a myth. The discovery of the human genome makes it possible to choose the most effective treatment with minimal adverse drug reactions for a particular patient.

Background: Amiodarone has a profound adverse toxicity profile. Large population-based analyses quantifying the risk of thyroid dysfunction (TD) in adults with and without congenital heart disease (ACHD) are lacking. Methods: All adults registered with a major German health insurer (≈9.2 million members) with amiodarone prescriptions were analyzed. Occurrence of amiodarone-associated TD was assessed. Results: Overall, 48,891 non-ACHD (37% female; median 73 years) and 886 ACHD (34% female; median 66 years) received amiodarone. Over 184,787 patient-years, 10,875 cases of TD occurred. The 10-year risk for TD was 38% in non-ACHD (35% ACHD). Within ACHD, compared to amiodarone-naïve patients, the hazard ratio (HR) for TD was 3.9 at 4 years after any amiodarone exposure. TD was associated with female gender (HR 1.42, p < 0.001) and younger age (HR 0.97 per 10 years, p = 0.009). Patients with congenital heart disease were not at increased risk (HR 0.98, p = 0.80). Diagnosis of complex congenital heart disease, however, was a predictor for TD (HR 1.56, p = 0.02). Amiodarone was continued in 47% of non-ACHD (38% ACHD), and 2.3% of non-ACHD (3.5% ACHD) underwent thyroid surgery/radiotherapy. Conclusions: Amiodarone-associated TD is common and comparable in non-ACHD and ACHD. While female gender and younger age are predictors for TD, congenital heart disease is not necessarily associated with an elevated risk.

Aim. Comparison of different treatment tactics – medicated antiarrhythmic therapy (AAT) and radiofrequency ablation (RFA) of elderly and senile pa- tients with relapsing atrial fibrillation (AF) as more severe patients with a burdened comorbid background.Material and methods. The study included 108 patients with paroxysmal and persistent AF who were in hospital and then under outpatient observation for 2 years. Depending on the method of treatment, patients were divided into 2 groups: the group receiving medicated AAT (n=45) and the group treated with RFA (63 patients). Most patients of the 2nd group (n=60) after the RFA received AAT, i.e. so-called hybrid therapy. These groups were comparable in age (mean age 64.9 and 64.7 years, respectively), sex and underlying pathology, comorbid diseases.Results. In patients who received "hybrid" therapy after 2 years of observation, it was more often possible to preserve the sinus rhythm and achieve a reduction in arrhythmia episodes in comparison with the drug group (95.2% and 86.6%, respectively). Quality of life and the frequency of complications of AAT in these groups of patients were comparable.Conclusion: In elderly and senile patients with paroxysmal and persistent atrial fibrillation, RFA and hybrid therapy was more effective for maintaining sinus rhythm compared to drug therapy. After RFA in this category of patients, in most cases, medicated AAT was used. When choosing the tactics of rational AAT in elderly patients, preference should be given to tactics in which it is possible to achieve an improvement in the quality of life.

Atrial fibrillation is associated with aging, obesity, heart disease, diabetes, and/or hypertension. Recent evidence suggests that parenchymal and vascular lung diseases increase atrial fibrillation risk. We review the epidemiology, clinical features, pathophysiologic mechanisms, and treatment implications of atrial fibrillation associated with diseases of the lungs and their vasculature, especially pulmonary hypertension. We also consider other features of pulmonary disease-associated atrial fibrillation. A key mediator of these conditions is right heart disease and right atrial remodeling. We pay particular attention to the pathophysiology and treatment challenges in atrial fibrillation associated with right heart disease induced by pulmonary diseases, including pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Aim. Catheter ablation (CA) is an effective approach for rhythm control in atrial fibrillation (AF), however antiarrhythmic therapy (AAT) remains important. There is a lack of data about long-term AAT use after CA. This study evaluates AAT after CA for AF.Material and methods. In 2012-2016, EURObservational Research Programme of Atrial Fibrillation Ablation Long-Term (EORP AFA L-T) registry was conducted, which included 476 Russian patients (57,1% — men; mean age — 57,1±8,7 years). The follow-up after CA was 12 months (available in 81,9% of patients). The use of AAT was evaluated prior to hospitalization, during hospitalization for CA, as well as at 3, 6 and 12 months of follow-up.Results. Prior to CA, 439 (92,2%) patients received AAT During CA, 459 (96,4%) patients were treated with AAT. After CA, AAT was used by 463 (97,3%), 370 (94,8%), and 307 (78,7%) patients at 3, 6 and 12 months of follow-up, respectively. There was no arrhythmia recurrence in 187 (47,9%) subjects. Among these patients, 40 (21,4%) received class IC or III AAT. The peak of AAT use was found for class IC agents within 3 months after CA (P

Aim. To analyze the results of 5-year follow-up of the paroxysmal atrial fibrillation patients (PAF) taking antiarrhythmic therapy (AAT)Material and methods. Patients (n=500) were selected to 11 groups: I — healthy, II — controls, III-XI — PAF taking AAT. The baseline parameters of heart rate variability (HRV) were assessed during 5-year follow-up.Results. Decrease of SDNN does 1,9 times increase the risk of AF development during the first 3 months from preventive AAT start. Decrease of RMSSD does 3,9 times increase the risk of AF during the first 2 weeks, and 1,9 times — 3 months; decrease of Delta X increases the risk of AF 3,9 times during 2 weeks, 2 times — during 3 months, 1,4 times — during 6 months, 1,3 times — during 12 months and 3 years. Increase of Amo does 1,8 times increase the risk of AF during first 3 months. If there was baseline decrease of Delta X and RMSSD, then within 2 weeks the AF paroxysm developed in 7,9% patients, and in 3 months — 15,9% patients. With the decrease of Delta X and RMSSD, in combination with low SDNN, the probability of sinus rhythm retention during 1 year is 51,2%.Conclusion. PAF patients taking preventive AAT demand for ECG assessment of HRV parameters no less than once per 3 months.

Background Based on its pharmacokinetic profile and electrophysiological effects in healthy horses, sotalol potentially could be used as a long‐term PO antiarrhythmic drug in horses. Objectives To evaluate the effect of sotalol on heart rate (HR), QT interval, atrial fibrillatory rate, and success of cardioversion in horses with naturally occurring chronic atrial fibrillation (AF). Animals Twenty‐eight horses referred for transvenous electrical cardioversion of AF were treated with 2 mg/kg sotalol PO q12h for 3 days before cardioversion, and 13 horses underwent the same protocol without sotalol administration. Methods Retrospective study. Before and after sotalol or no treatment, the HR was measured at rest and during an exercise test. The QT interval and atrial fibrillation cycle length (AFCL) were measured at rest using tissue Doppler velocity imaging. Results In the control group, no significant differences were found between the 2 examinations. In the sotalol group, the HR at rest and during exercise was significantly lower after sotalol treatment, whereas the QT interval and AFCL measured by tissue Doppler increased significantly. Cardioversion to sinus rhythm was achieved in 25/28 horses in the sotalol group and all horses in the control group, but the median number of shocks and energy at cardioversion were significantly lower in the sotalol group. Conclusions and Clinical Importance In horses with AF, sotalol administration results in class III antiarrhythmic effects and β‐blocking activity, with moderate HR reduction during exercise.

Objective. To determine criteria for choosing management tactics in patients with ventricular arrhythmias (VA) in the absence of structural heart disease from the point of view of physicians and patients in clinical practice and to compare the immediate results of antiarrhythmic drug therapy (ADT) and radiofrequency ablation (RFA) with the trends in arrhythmic syndrome in the non-treatment group. Subjects and methods. Examinations were made in 90 patients (23 men and 67 women) (mean age, 44 (31; 57) years) with VA in the absence of structural heart disease. Preference was given to RFA (n = 32 (36%)), ADT (n = 37 (41%)), and follow-up tactics (n = 21 (23%)). At baseline and 1 month, Holter ECG monitoring was done; quality of life (QOL) was assessed; and anxiety and depression levels were detected using the SF-36 and HADS questionnaires. In addition, 71 physicians were surveyed about their preferences to the treatment of VA in individuals without structural heart disease. Results. In the total group of patients, VA was unambiguously accompanied by the symptoms only in 47%. The signs of anxiety and depression were identified in 41 and 14% of cases, respectively. The efficiency of RFA was comparable to that of ADT (p > 0.1): a positive antiarrhythmic effect was observed in 71.9% of the patients in the RFA group and in 67.6% in the ADT group. During one month, 38.1% of the patients in the follow-up group showed a spontaneous substantial reduction in the number of ventricular premature beats (VPBs) or disappearance of unstable ventricular tachycardia (UVT), which met the criteria for a positive effect. At baseline, the QOL indicators on a social functioning scale in the RFA group were worse than those in the ADT group. At the same time, most QOL indicators in the patients who have chosen a wait-and-see tactic were significantly higher than those in the RFA and ADT subgroups. The patients treated with ethacyzin in the ADT group more frequently achieved a positive effect. In the interviewed physicians’ opinion, the choice of a tactic depended on the impact of arrhythmia on health status (68%), the number of VPBs per day (61%), and the presence of UVT (56%). RFA or ADT was most often recommended when there were 10,000-15,000 or more VPBs per day ((49 and 35% of the respondents, respectively). 46.5% of the respondents stated that β-blockers were the drug of choice for idiopathic frequent VPBs. Only 30% of the respondents considered it appropriate to restrict to a follow-up in the presence of asymptomatic VPBs. Conclusion. Patient management in clinical practice generally complies with the current guidelines; however, much importance is attached to the severity of arrhythmia (the number of VPBs per day, the presence of UVT) in addition to the presence of symptoms. In the opinion of most physicians, the initiation of treatment is justified when there are 10,000-15,000 and more per day. QOL assessment may be promising in choosing the optimal management tactics for these patients. Treatment should not be initiated immediately in patients with a high level of QOL, especially in those with arrhythmia lasting less than 12 months, by taking into account that there can be a spontaneous improvement in 38% of cases within the next month. The immediate results of ADT and RFA are comparable in patients with VA in the absence of structural heart disease. The Class IC antiarrhythmic drug ethacyzin is the most effective agent that ensures positive changes in arrhythmic syndrome in 66.7% of cases with the rate of side effects being in 17.8%.

Background: Catheter ablation (CA) is an established therapeutic modality for ventricular tachycardia (VT).Objective: We compared the clinical outcomes of CA for VT vs medical therapy from all previously performed randomized controlled trials (RCTs) and compared these to contemporary observational studies.Methods: A comprehensive database search through to August 2018 identified 8 eligible studies enrolling 797 patients.Results: In RCTs, VT recurrence and electrical VT storm were significantly reduced in the CA group vs medical therapy group (relative risk [RR] 0.78, 95% confidence interval [CI] 0.64-0.95, P = .01; RR 0.70, 95% CI 0.51-0.94, P = .02, respectively) at a mean follow-up of 22 months. All-cause or cardiac-specific mortality did not differ significantly (RR 0.92, 95% CI 0.67-1.27, P = .62; RR 0.82, 95% CI 0.54-1.26, P = .37, respectively). In 4 observational studies, including 3065 patients with a mean follow-up of 18.2 months, VT recurrence and mortality were significantly lower as compared to the RCTs (28.6% vs 39%, P < .001; 13.2% vs 18%, P = .01, respectively) despite greater incidence of electrical storm (33.2% vs 17%, P < .001), higher prevalence of nonischemic substrate (46.4% vs 3.6%, P < .001), and lower rate of implanted ICDs (68% vs 94.7%, P < .001).Conclusion: Meta-analysis of RCT data shows that CA is superior to medical therapy for predominantly postinfarct, scar-related VT in terms of VT recurrence and electrical VT storm, with no reduction in mortality. Real-world observational studies also demonstrate significant reduction in VT recurrence and mortality, despite a sicker cohort, demonstrating replicability and translation of RCT data in the real world. [ABSTRACT FROM AUTHOR]

T he article focuses on the main debating and unresolved issues on atrial fibrillation patients therapy, e.g. anticoagulation, antiarrhythmic, intervention and surgical tactics. The weaknesses and disadvantages are discussed, of the modern conservative and invasive strategies, as of the modern classification of atrial fibrillation; the issues on optimal rhythm control in atrial fibrillation, and early diagnostics. Each of these problems is related to the range of opportunities for better understanding and management.

Atypical presentations of supraventricular arrhythmias constitute a diagnostic challenge which are not frequently reported in literature. Swallowing-induced supraventricular arrhythmia (SI-SVA), which was first described in 1926, is an intriguing presentation of supraventricular tachycardia and occurs during a wet or solid swallow. A 67-year-old man presented to our outpatient clinic complaining from recurrent episodes of sensation of palpitations and short duration pressure on his chest while swallowing since the last 2 weeks. Ambulatory rhythm Holter monitoring was suggestive of atrial fibrillation (AF) or atrial tachycardia attacks during swallowing. In addition, electrocardiography performed during solid food swallowing, showed short duration of AF consistent with the patient's symptoms. The patient was successfully treated with amiodarone. The main cause of SI-SVA is not known. Cross-talk of nerves during the impulse propagation might be the underlying cause of this phenomenon. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF), the most common cardiac arrhythmia, is widely associated with inflammation, vascular dysfunction, and elevated levels of the vascular leak-inducing cytokine, vascular endothelial growth factor (VEGF). Mechanisms underlying AF are poorly understood and current treatments only manage this progressive disease, rather than arresting the underlying pathology. The authors previously identified edema-induced disruption of sodium channel (NaV1.5)-rich intercalated disk nanodomains as a novel mechanism for AF initiation secondary to acute inflammation. Therefore, we hypothesized that protecting the vascular barrier can prevent vascular leak-induced atrial arrhythmias., Objectives: In this study the authors tested the hypothesis that protecting the vascular barrier can prevent vascular leak-induced atrial arrhythmias. They identified 2 molecular targets for vascular barrier protection, connexin43 (Cx43) hemichannels and pannexin-1 (Panx1) channels, which have been implicated in cytokine-induced vascular leak., Methods: The authors undertook in vivo electrocardiography, electron microscopy, and super-resolution light microscopy studies in mice acutely treated with a clinically relevant level of VEGF., Results: AF incidence was increased in untreated mice exposed to VEGF relative to vehicle control subjects. VEGF also increased the average number of AF episodes. VEGF shifted Na V 1.5 signal to longer distances from Cx43 gap junctions, measured by a distance transformation-based spatial analysis of 3-dimensional confocal images of intercalated disks. Similar effects were observed with Na V 1.5 localized near mechanical junctions composed of neural cadherin. Blocking connexin43 hemichannels (αCT11 peptide) or Panx1 channels (PxIL2P peptide) significantly reduced the duration of AF episodes compared with VEGF alone with no treatment. Concurrently, both peptide therapies preserved Na V 1.5 distance from gap junctions to control levels and reduced mechanical junction-adjacent intermembrane distance in these hearts. Notably, similar antiarrhythmic efficacy was also achieved with clinically-relevant small-molecule inhibitors of Cx43 and Panx1., Conclusions: These results highlight vascular barrier protection as an antiarrhythmic strategy following inflammation-induced vascular leak., Competing Interests: Funding Support and Author Disclosures This work was supported by grants from the National Institutes of Health (R01 HL148736 and R01 HL165751 awarded to Dr Veeraraghavan), and the American Heart Association (20TPA35460040 awarded to Dr Veeraraghavan and a predoctoral fellowship awarded to Dr Mezache). The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Premature ventricular contractions (PVCs) are common and are considered benign in the absence of structural heart disease. However, high burden of PVCs potentially on 24-hour Holter monitoring, can potentially cause left ventricular dysfunction. In this case, catheter ablation has been demonstrated to be effective at PVC suppression and is associated with improvement or normalization of ventricular function. This form of reversible ventricular dysfunction termed as PVC cardiomyopathy and its pathogenesis is poorly understood at the current time. [ABSTRACT FROM AUTHOR]

Cardiac arrhythmias remain a common challenge and are associated with significant morbidity and mortality. Effective and safe rhythm control strategies are a primary, yet unmet need in everyday clinical practice. Despite significant pharmacological and technological advances, including catheter ablation and device-based therapies, the development of more effective alternatives is of significant interest to increase quality of life and to reduce symptom burden, hospitalizations and mortality. The mechanistic understanding of pathophysiological pathways underlying cardiac arrhythmias has advanced profoundly, opening up novel avenues for mechanism-based therapeutic approaches. Current management of arrhythmias, however, is primarily guided by clinical and demographic characteristics of patient groups as opposed to individual, patient-specific mechanisms and pheno-/genotyping. With this state-of-the-art paper, the Working Group on Cellular Electrophysiology of the German Cardiac Society aims to close the gap between advanced molecular understanding and clinical decision-making in cardiac electrophysiology. The significance of cellular electrophysiological findings for clinical arrhythmia management constitutes the main focus of this document. Clinically relevant knowledge of pathophysiological pathways of arrhythmias and cellular mechanisms of antiarrhythmic interventions are summarized. Furthermore, the specific molecular background for the initiation and perpetuation of atrial and ventricular arrhythmias and mechanism-based strategies for therapeutic interventions are highlighted. Current "hot topics" in atrial fibrillation are critically appraised. Finally, the establishment and support of cellular and translational electrophysiology programs in clinical rhythmology departments is called for to improve basic-science-guided patient management. [ABSTRACT FROM AUTHOR]

In November 2017, the American Heart Association published updates to its adult and pediatric Basic Life Support and Cardiopulmonary Resuscitation guidelines; one year later, it published updates to its Advanced Cardiovascular Life Support and Pediatric Advanced Life Support guidelines. This article reviews these updated guidelines and highlights the key changes and how to integrate them into practice. [ABSTRACT FROM AUTHOR]

Abstract Two-pore-domain potassium (K 2P) channels conduct background potassium currents in the heart and other tissues. K 2P currents are involved in the repolarization of action potentials and stabilize the resting membrane potential. Human K 2P 13.1 (THIK-1) channels are expressed in the heart and have recently been implicated in atrial fibrillation. The in vivo significance of K 2P 13.1 currents in cardiac electrophysiology is not known. We hypothesized that Danio rerio (zebrafish) may serve as model to elucidate the functional role of cardiac K 2P 13.1 channels. This work was designed to characterize zebrafish orthologs of K 2P 13.1. Two zkcnk13 coding sequences were identified by DNA database searches and amplified from zebrafish cDNA. Human and zebrafish K 2P 13.1 proteins exhibit 70% (K 2P 13.1a) and 66% (K 2P 13.1b) identity. Kcnk13 expression in zebrafish was studied using polymerase chain reaction. Zebrafish kcnk13a and z kcnk13b mRNAs were detected in brain and heart. Human and zebrafish K 2P 13.1 currents were analyzed in the Xenopus oocyte expression system by voltage clamp electrophysiology. Zebrafish K 2P 13.1a polypeptides were non-functional, while zK 2P 13.1b channels exhibited K+ selective, outwardly rectifying currents. Zebrafish and human K 2P 13.1 currents were similarly activated by arachidonic acid and reduced by barium, mexiletine, lidocaine, and inhibition of phospholipase C. In conclusion, zebrafish K 2P 13.1b channels and their human orthologs exhibit structural and regulatory similarities. Zebrafish may be used as in vivo model for the assessment of physiology and therapeutic significance of K 2P 13.1. Highlights • Two kcnk 13 (THIK-1) orthologs were cloned from zebrafish cDNA. • K 2P 13.1a subunits do not give rise to functional ion channels. • Human K 2P 13.1 and zebrafish K 2P 13.1b show similar biophysical characteristics and regulation. • hK 2P 13.1 and zK 2P 13.1s are activated by arachidonic acid and blocked by mexiletine and lidocaine. • Zebrafish could be employed as model system for physiological K 2P 13.1 in vivo studies. [ABSTRACT FROM AUTHOR]

In recent years, progress has been made in the study of the natural history of atrial fibrillation (AF) - that, from the stage of having no clinical manifestations, to the final stage, which is an irreversible arrhythmia, is associated with the development of serious cardiovascular complications. Most AF patients steadily progress in persistent or permanent form, but the risk factors and predictors of progression of the arrhythmia is not clearly defined. There is little research done on the effect of long-term antiarrhythmic therapy on the progression of AF. Objective. To evaluate the progression of arrhythmias in patients with arterial hypertension (AH) with paroxysmal AF in the treatment of propafenone (propanorm) compared to treatment with bisoprolol (Concor) in the long-term prospective study. Materials and methods. The study included 62 patients with essential hypertension aged 45 to 63 years. Patients were randomized into 2 groups: 32 patients in group 1 for storing heart rate propafenone took a daily dose of 450 mg, 30 patients in group 2 to control ventricular rate was appointed bisoprolol. Prospective monitoring of patients was carried out from 2011 to 2015, the progression of the arrhythmia was considered: increase in the frequency of paroxysms of arrhythmia in the last 3 months, the appearance of long-term persistent AF episodes or persistent AF. Results. In 14 (44%) patients in group 1 and 20 (67%) - group 2 5 years of observation, it was noted increase in the frequency and duration of AF episodes. The average value of arrhythmia progression into a more stable form of 9.3% per year in patients receiving propafenone, and 11.5% - bisoprolol (p=0.007). Keeping the treatment of sinus rhythm propafenone in a daily dose of 450 mg contributed to a significant reduction of the left atrium anteroposterior size from 43±3 to 36±3 mm (p=0.03). In the treatment with bisoprolol anteroposterior size of the left atrium was not significantly changed and amounted to 44±3 and 43±3 mm respectively. Portability of propafenone antiarrhythmic therapy was comparable with that of bisoprolol. No severe or serious side effects were observed in patients during the long-term prospective study. Conclusion. The five-year propafenone treatment of hypertensive patients with paroxysmal AF can reduce the progression of AF in a more stable form compared with bisoprolol therapy.

Modern approaches to antiarrhythmic anti-relapse therapy of atrial fibrillation are considered. Advantages and disadvantages of the main therapeutic strategies are discussed from the standpoint of evidence-based medicine. The value of strategies of rhythm control, heart rate control and «upstream therapy» in the management of patients with atrial fibrillation is specified. Results of clinical studies on the efficacy and safety of anti-arrhythmic drugs, the search for such new drugs are presented. The authors state, that possibilities of modern drug therapy are limited, development and efficiency of other methods of anti-relapse therapy are low, new groups of drugs are not effective enough or are far from clinical applications. At that the adherence to treatment of patients with atrial fibrillation is unstudied, and its influence on the treatment outcomes, prevention of complications and long-term prognosis are ignored. Authors concluded that in conditions of limited capacity for drug therapy, evaluation of the effect of adherence to treatment in patients with atrial fibrillation, and elaboration on this basis the principles and tools of therapy, taking into account social and personal characteristics, are the most perspective directions of modern arrhythmology.

Data on atrial fibrillation (AF) epidemiology and AF influence on the risk of cardiovascular complications are presented. Principles and tactics of AF therapy are discussed in accordance to evidence based medicine and European society of cardiology Guidelines. Algorithms for choice (on the basis of risk stratification) of different antiarrhythmic drugs and anticoagulants are described. Perspectives in improvement of efficacy and safety of AF therapy are reviewed.

Basic principles of the management of patients with atrial fibrillation (AF) are discussed taking into account recommendations of the European Society of Cardiology (2010). Peculiarities of AF diagnosis, clinical course and severity estimation, approaches to complications prevention and therapy strategy choice in patients with AF (rhythm control or heart rate control) are presented.

Aim. To evaluate effects of angiotensin converting enzyme inhibitor spirapril on efficacy of preventive antiarrhythmic therapy in patients with paroxysmal atrial fibrillation (AF).Material and methods. 40 patients with paroxysmal AF were involved in open-label, cross-over study with periods of antiarrhythmic drug withdrawal. During 3 months all patients received by turns two types of therapy: combination of preventive antiarrhythmic therapy with spirapril 6 mg once daily - (CT group) or preventive antiarrhythmic therapy only (AT group).Results. AF-free intervals to the first and the second AF paroxysms during antiarrhythmic drug withdrawal were comparable ) in AT and CT groups (p=0,4 and p=0,6, respectively, logrank test).Conclusion. Spirapril added to the basic preventive antiarrhythmic therapy during 3 months had no effect on the length of interictal period in paroxysmal AF.

The purpose of this article is to discuss the issues related to the treatment of patients with paroxysmal and persistent atrial fibrillation (AF). The article discusses the indications for patients with radiofrequency catheter (RFC) ablation of the mouths of the pulmonary veins and based on the results of randomized clinical trials analyzed the clinical effects of this procedure, depending on the type of AF. The article discusses the initiation of antiarrhythmic therapy and the duration of its application after RFC.